Dr Le Fanu's online health clinic, Monday 15th October 2012

Concerned about aches and pains? Worried about a medical condition? You can
email your questions confidentially to Dr Le Fanu at
drjames@telegraph.co.uk. Answers will be published in the health section of
the Telegraph website on Friday morning. This week's answers are below.

I read your medical article with interest and wonder if you can help with my symptom.

I wake up every morning with the most awful sour taste in my mouth and can't wait to clean my teeth and brush my tongue to help get rid of it. Over the years, I have been treated once for Helicobacter Pylori (when it was proven I had the condition). Twice more I have received the same treatment in case it had returned.

I have been treated with Nystatin, in case the cause was thrush. This helped relieve the coating on my tongue but not the nasty taste. I have tried a prescribed mouthwash for Halitosis and I have had two goes at treating gastric reflux with Omeprazole and Lamoprazole. These two goes resulted in the condition becoming unbearably worse. I have undergone an endoscopy which proved all well except slight inflammation of the duodenum.

All these treatments have done nothing to alleviate the problem. I have no swellings on my neck or mouth and, apart from taking NeoClarityn for an allergy (I think to dairy products) and Deslofloratidine nasal spray to help with the allergy rhinitis, I have no other problems. I have good teeth which are regularly checked. I do suffer from a lack of taste and smell which is helped by the nasal spray.

Thanks for your query - and my sympathies for this distressing sour taste in your mouth, known as Dysgeusia. This can be as you have discovered, a difficult condition to treat though I know your doctor has sought to remedy potential causes such as Helicobacter infection. It is possible that the alteration in taste and smell due to your allergic rhinitis may be a contributory factor - and it would certainly be sensible to discuss with your doctor the possibility of a trial of steroids (or a steroid nasal spray) to see if this improves matters. Beyond that you may know the trace element zinc has an important role in the functioning of the taste buds and it is claimed that zinc supplements can be of value.

Dear Dr. LeFanu,

Please can you explain Psoriatic Arthritis? Our son has been diagnosed with this condition. He is 38 years old. Will treatment control the situation?

Mary Vallance

Dear Ms Vallance,

Thanks for your query on behalf of your son. I am sure his rheumatology specialist is in the best position to advise on appropriate treatment for his condition - which will depend on which of the several (five) different types he has.

Dear Dr James

Seven years ago my mother (who is now 82) was diagnosed with Polimyalgia Rhumatica, (the day after her GP started her on statins!!!!) She has since been on a cocktail of different drugs including steriods (doses vary but at the moment 15mgs a day) More recently she has become doubley incontinent (she doesn't even know it is happening) and is having additional pain in her back and hip.

Three and a half years ago I was also diagnosed with PMR and after 30 months on steriods I came off them (slowly) and I am now managing my pain with tramadol and pregablin. I too am having terrible 'bladder' trouble and similar problems as my mother. Do you know if there is any research into herditary PMR? I am so concerned that at 59 I am going to have the same troubles as Mummy. She is awaiting an MRI scan and is now seeing an orthopod.

Could you put me in touch with any research programmes for PMR?

Many thanks,

Debbie Silcock

Dear Ms Silcock,

Thanks for your query. I quite understand that given your mother’s experience with PMR that you too should be apprehensive you might have similar problems. There certainly can be a genetic element involved but for most (including probably yourself) the cause not known. There must be, I suspect, some other explanation for your mother’s incontinence problems as it is certainly not a feature of PMR, and I trust these scans you mention will clarify what is going on. Similarly I would doubt the ‘bladder’ problems (whatever they might be) you mention are related to the PMR and these would need to be sorted out on her own account. I note you are no longer taking steroids but would have thought the anti-inflammatory drugs such as Voltarol are probably the preferred treatment for your present symptoms rather than the Pregabalin and Tramadol you mention.

Dear Sir,

I have what I call an ‘episode’ every 4 or 5 weeks when I wake up feeling wretched, unwell and with a headache. I retch up about a quarter of a glass of saliva/clear liquid first thing. I can only eat dry toast, grapes, tea and Oxo that day. The next day I am fairly back to normal but do not fancy coffee or alcohol and have very rosy cheeks. This has been going on for about 8 years. I am 82, taking medicines for Osteoporosis, Acid Reflux and High Blood pressure. Can you suggest what this is please.

Yours sincerely,

Mrs S. Midgley

Dear Mrs Midgley,

Thanks for being in touch. I would have thought it most likely that these episodes of nausea and headaches is a condition known as ‘Abdominal migraine’, which like the classic form might be precipitated by stress or dietary factors - but usually just happens. In some people a small dose of aspirin or a beta blocker can be a fairly effective preventive measure while the antimigraine drug Sumatriptan can ameliorate the severity and duration of symptoms.

Dear Doctor,

In 1996 when I reached my 60th birthday, I commenced having an annual flu jab and it was then or soon after that I also had a pneumonia 10 year immunity jab. In December 2009, I was surprised therefore when I was diagnosed with pneumonia. The GP (who looked after me very well) told me that I should consider having a further pneumonia jab. When I booked an appointment for the annual flu jab in October 2010, and requested a repeat pneumonia jab, I was told by the practice nurse that it was not possible to repeat it or was recommended. If you think this may be a financial restraint by the NHS, I would be happy to pay privately.

I would very much value your pearls of wisdom.

Thank you,

Cynthia Brett

Dear Ms Brett,

Thanks for your query. The pneumonia jab is only effective against a type of pneumonia caused by the bacterium pneumococcus that accounts for around 50% of cases. I can only presume your recent bout must have been due to some other infective cause. Regrettably I can’t tell you why the practice nurse advised a further jab was ‘not recommended’ as it is generally recommended as a routine measure for those over the age of 65.

Your article on 8th October was of great interest to me as I too have “visits”. My first unwelcome “visitor” was about four years ago, when I developed what I thought was a sore throat. As the time went on my throat began to swell, making it difficult to swallow. I visited my GP who was on the point of admitting me to hospital but after a telephone consultation with an oral specialist, was advised to take steroids for 3 weeks and stop taking Ramipiril. The swelling was almost gone after three hours, leaving just a raw feeling in my throat.

It was several months before I had another “visit” not my throat this time but my tongue!! Again I visited my GP and was advised if the swelling didn’t go down some time soon, to dial 999 and call an ambulance!! I was prescribed antihistamines, which helped and have since been referred to an oral specialist at Treliske Hospital, Truro, Cornwall. After several appointments with him, the cause of my “visits” are still unknown.

I’ve had several “visits”, including a hideously swollen lip, tongue and cheek, with more frequency, since taking the antihistamines, none. I was advised to stop taking the antihistamines at one point, but after a day my “visitor” returned, so now I am back on 2 a day.

The irony of this is that I am on 2 lots of medication, namely Indapamide 1.5mg, 1 a day and Gliclazide 80mg, 2 a day, both of which have possible side effects of facial swelling! The oral specialist thinks this would not be the cause of my “visits” as the antihistamines prevent them.

To date I am awaiting an appointment to go to Derriford Hospital in Plymouth, Devon, to attend their Immunology department.

I have raised blood pressure and type 2 Diabetes. I will be 76 on 14-10-12.

Allen Le Couteur Bisson

Dear Mr Bisson,

Thanks for your query.The swelling of the lips and mouth, as you will know, is the allergic condition known as Angioneurotic Oedema and as you have found can be prevented or controlled with antihistamines. I would have thought the Indapamide you are taking for your raised blood pressure almost certainly accounts for your persistent episodes and would suggest discussing with your doctor switching to some other medication that does not have these side effects.

Dear Doctor,

Could you please advise me on the following problem :

For many months I have been troubled with exceptionalexcessive flatulence, Sometimes causing pain in the lower bowel due to “trapped wind”. I have mentioned it to my GP but he doesn’t seem to be unduly concerned, he quoted “a windy nation is a healthy nation “!

I suffer from Osteoarthritis, Spondoloses and Pagets disease in the Pelvis. These cause be considerable pain and I take Co-codomol on prescription four times a day. They bring relief but apart from constipation ( I take “movicol” for relief) the main problem is this EXCESSIVE flatulence. I have tried taking medicinal charcoal with some slight relief. I to not avoid bran products which I know can cause wind but they do helpwith the other matters. Have you any advice ?

Many thanks,

K. Tomlinson

Dear Mr Tomlinson,

Thanks for your query. This persistent flatulence you are so troubled with is most likely due to the Movicol you are taking for the constipation caused by the strong painkillers for your arthritic pains. I would have thought that switching to some other form of laxative might solve this problem.

Dear Dr.Le Fanu,

Because I had a heart rate of 40 with no other related symptoms I was fitted with a pacemaker in August 2009. All was OK until in January this year while sitting quietly I suddenly felt dizzy, cold and sweaty. I checked my Bp which proved normal but my pulse rate was 40 - my pacemaker was set at 60 minimum. After about 30 minutes with no improvement I thought it probable that my pacemaker had failed to kick in so I gave it a sharp pat. My pulse rate immediately increased to 60 and within 10 minutes I felt fine. The next day I saw my doctor and the following day i visited the pacemaker clinic where I was told all was well and that my pulse had at no time dropped below 60. When I disagreed I was told that pulse rate was sometimes difficult to measure accurately and that even some doctors get it wrong.

Since January things have become curiouser and curiouser. I suffer from tinitis which usually sounds like a steady gas leak. After a while I realised that when my pulse was apparently slow it was actually irregular - missing one beat in 3, 4, or 5. Not only could I feel this at my wrist but I could hear the rhythm in my tinitis. So far this has only occurred when I am relaxed - just walking across the room is sufficient to put things back to normal Persistence has allowed me to see two consultants who differed in their explanations which were outside my understanding but supposed to be reassuring.

For a while I continued to record my Bp and pulse rate but gave it up when no one seemed interested. During one visit to the surgery the irregularity occurred - confirmed manually by the doctor - but the walk to the ECG machine sent it back to normal.

The latest development sounds like something from a Bond movie. A friend was a research physicist who is still interested in all sorts of electronic beams. He came to Gosport a few weeks ago and came across an unfamiliar radar beam. Asked if it could possibly cause problems with my pacemaker he said that if this beams frequency was close to that of my pacemaker it probably could. He said that since this beam might well have something to do a Government research establishment close to my home he could not tell me its working frequency - Official Secrets and all that! However, if I could tell him the frequency on which my pacemaker worked he would be able to confirm whether or not it could be the culprit. Since then I have been trying to get that information. A spokesperson for the Pacemaker Clinic assured that, as it was electromagnetic it didn't have a frequency. I contacted the MHRA who told me that disclosure of such technical information is outside their remit.

From a copy letter from the clinic to my doctor I understand I have a`Sorin Biomedica Symphony 2550 but when I googled I was told that the frequency is set by the people when it is inserted but they have told me it doesn't exist.

This does not seem to be life threatening but I hope you find it of enough interest to give it some thought.

Yours sincerely,

Michael Urry

Dear Mr Urry,

Thanks for your lengthy and fascinating account of the travails with your pacemaker. Regrettably it falls (far outside) my expertise to have an opinion on whether this might be related to the electro magnetic frequency of the government research establishment you mention. It does however sound as if the pacemaker is underperforming if you have a slow pulse and interposed additional beats. You may need to discuss this as your next appointment.

Dear Doctor,

You mentioned a correspondent, who suffered various symptoms including swelling of the tongue. I have suffered from this at irregular intervals but usually every few weeks, without any doctor being able to find a reason or a cure.

It usually wakes me in the middle of the night, without an awareness of why I have woken up. I immediately take an antihistamine, sometimes more than one and with a bit of luck, the swelling which can be in either side of the tongue, gradually subsides. Until it does, it is very worrying because I don't know whether it is going to impede my breathing.

I have been to every type of doctor, including an ENS consultant, allergy clinic and allergy specialist to no avail. Initially it was thought that the allergy could be medication caused and I have stopped taking statins and also a Ramipril but nothing has change.

I do not suffer from related lethargy but I have a could of times had swelling of other parts of my face.

Any ideas would be much appreciated. For your information, I am 85 years old and otherwise in good health.

Mrs Carola Zentner

Dear Mrs Zentner,

Thanks for your query. This condition (as with Mr Bisson above) is known as Angioneurotic Oedema and in the absence of any obvious cause is best controlled by taking a regular dose of antihistamine such as Zirtec.

Dear Dr Le Fanu,

I am 74 years old and have had no problems previously with one gallstone, 15cms, which was noticed on a scan 12 years ago. In July I felt uncomfortable on the right side, just below the breastbone, several times a week, but I have not had to take painkillers and it is more of a discomfort than pain.

I was referred to a Consultant [and it was a Consultant] at the hospital, but as I have bronchiectasis, asthma,hypothyroidism and coeliac disease I am reluctant to have a general anaesthetic. I have had two major operations by spinal anaesthetic and a number of minor operations by local anaesthetic, and was told once by a doctor [that was not my own] that I was the talk of the staff room and that I was quite right to hold out against one.

I therefore asked the Consultant for the gallstones about alternative treatments eg lipotripsy and medications and was told three times that there were no other treatments available except removal of the gallstones by surgery, even though I pointed out that both were mentioned on the NHS web-site! He suggested that there might be clinical trials and that I could do my own research and return to see him in six months time and he would have a look at the research. As for medication he only approved of taking calcium.

I have discovered from a friend who thought that St Georges Hospital in Tooting did the laser treatment, but do you know of any other NHS or Private hospital that undertook this treatment or medication? I live in Surrey.

Thank you for your help.

Regards,

G. Goddard

Dear Mr Goddard,

Thanks for being in touch. I confess to being a bit puzzled about your consultant’s comments as there are indeed alternatives (if not ideal) to keyhole surgery for gallstones. The medical dissolving treatment is known as Ursodeoxycholic acid - though this has a drawback that the gallstones tend to recur. The stone shattering Lithotripsy option is less successful than for kidney stones but you should perhaps consult Dr Roland Ede (01322 272168) who has expertise in this field.

Dear Doctor,

I broke my collar bone 18 months ago, from which I recovered quickly (playing golf 6 weeks later). At the time it was excruciatingly painful and sleep was allmost impossible but being self employed I couldn't rest at home and kept working but now when decorating or gardening, for example, I get a strange uncomfortable feeling, aching and almost like having a buzzing bee inside my collar bone. Is it tendon damage? My friend broke his arm and also explained unusual physical stress as seeming like having a fly inside his bone where it broke. Help!

JDS

Dear JDS,

This persistent discomfort and buzzing at the site of a healed fracture is well recognised (if unexplained) being particularly associated with the sort of extra exertion which may be involved with decorating or gardening.It should, resolve with time.

Dear Dr LeFanu

Four times in the last six months, I have experienced, sever and excruciating pain at night in either one or both of my legs which lasts for 5 to 10 minutes.

This has always occurred on a Friday night after our usually routine of fish & chips for our evening meal and a tot of malt whisky before retiring to bed

Yours sincerely,

T.Allsopp

Dear Mr Allsopp,

Thanks for your most interesting query. This certainly sounds like nocturnal cramps and my main suggestion would be that you should perhaps abstain from fish and chips and whisky on Friday nights for the next six months to see if these excruciating pains disappear.

Dear Dr James,

Thank you for your comments in your Telegraph health section. The only other details I can offer are that I do suffer from heartburn for which I take Ranitidine (150mg twice a day). I am not allowed other esomeprazole type drugs as I take Imatinib for CML. My GP has arranged for me to see a dermatologist and an ENT specialist. I have previously seen an ENT specialist for a condition in my left ear which resulted in the removal of most of the inner ear workings. He signed me off last year after 5 years, but I have an appointment to see him again soon to see if he can shed any light on the recurrence of the blisters on my tongue. With thanks. This is what the b/blister looks like!

Re. todays conundrum, Monday October 8th, I would suggest Mrs BJ is possibly suffering from allergy to mould spores which are endemic in the air at all times but in particular in damp weather and before and after rain. Some moulds also spore in dry windy weather. I have suffered all my life and have got used to suddenly getting blisters in my mouth and burning lips. I love gardening which if I do too much aggravates the problem and I colapse into the chair incapable. Moulds are well known to cause drowsiness and I met a patient once who upset her family by always falling asleep in the theatre and cinema. These are two situations where there is always damp air due to lack of ventilation. Probably better now with air conditioning. I would also suggest that anti acids are the last thing on earth she should take. Moulds are known to inhibit digestion and I myself produce very little stomach acid and take supplements to eat. Achlorhydria is very often missed as the symptoms are much the same as producing too much acid. Hope this info is helpful. Immunotherapy at The Burghwood clinic keeps me generally in control, but I too every few weeks seem to have a bad day, and I have wondered whether because moulds are toxic I simply become overloaded.

Jacquie Broadway

Dear Ms Broadway,

Thanks for the further details and that excellent photograph of your mouth blister. These, as you may know, can be a side effect of the Imatinib you are currently taking for your CML - and should resolve with luck when the treatment is completed. Thanks too for your most interesting contribution to the swelling mouth conundrum. I confess I had not encountered the possibility before that this might be due to an allergy to mould spores and am grateful to you for bringing it to my attention.

Dear Dr. LeFanu,

I recently had half a dozen crusty moles or warts on my back ‘zapped’ with liquid nitrogen. Now a whole new cluster of small ‘growths’ has appeared on my back (my wife says there must be about 50).

When I had similar treatment a few years ago, the same thing happened. When I suggested to my then doctor that perhaps the liquid nitrogen had stimulated the skin to produce these new lesions (or whatever they are) he said this was not possible since the ‘gun’ administering the dosage was aimed very precisely.

Is there an explanation for this new ‘mushrooming’? Do you think I should ask my new doctor about it?

Kind regards

Dear Anon,

Thanks for your most interesting question, again I must confess to having not encountered before this resurgence of warts after liquid nitrogen treatment - and was quite unable to find any mention of it in my reputable dermatology textbook. You should certainly discuss this with your new doctor.

Hi Doc,

My problem is every time I pass water the ned of my penis hurts. I've had numerouse specimens taken and they have come back with a negastive response. I attended Derriford hospital and seen a consultant, and a series of tests carried out, namely a ultracsound check which was again negative, a further test was carried out to check for stones, again negative.The consultant via my doctor was to put me on a long time Anti-biotic, namely CAFALEXIN, I've been taking them for the last, 6 weeks to no effect.Your advbice would be apprecative.

Rgds Richard C

Dear Mr C,

Thanks for being in touch. This pain at the tip of the penis is likely to be ‘referred’ from inflammation of the prostate gland known as Prostatitis. This is treated as in your case with an antibiotic - though it may take up to a couple of months to work effectively. If the pain persists after this period your doctor will no doubt wish to review the situation.

Dear Dr leFanu

For many years I have been troubled badly by mucus, night and day. Despite having cut out dairy products almost completely, it persists, although seldom now causing me to choke. If you or any of your readers could suggest a remedy, I would be most grateful.

Incidentally, possibly as the result of the virtually dairy-free diet, I cannot keep fingernails intact, my thumbnails being permanently split, so that I must cover them with Micropore. Oddly, my toenailtoughs, are .

Your ‘Telegraph’ column performs a great, much needed service.

Sincerely,

Bernard Vass

Dear Mr Vass,

Thanks for your query and my sympathies concerning this chronic mucus problem. This can be due to a chronic low grade infection of the sinuses and several readers over the years have commented on how much they have been helped from a longish cause of antibiotics such Chloromycetin.

Dear Dr,

I have a problem with recurring nightmares, which have become increasing in occurrence and intensity during the last year. My medical history is complicated. I am a 70 year old woman, and I had an acoustic neuroma removed in 1982. It was the size of a hen's egg, and I was fortunate that it could be fully removed, leaving me with left sided weakness, a severed trigenimal nerve, vertigo, and of course, no hearing in the left ear.

I made a good recovery and eventually returned to teaching in a comprehensive school, when I finally had to have a medical retirement in 1995 at the age of 53.

With increasing age, my neurologist has explained to me that, the ability of the body to compensate for the damage to the brain is weakened, especially if I am tired or not in good health. My problems are compounded by osteoarthritis. I had half foot replacements in 2007 and 2008. The neck is also badly affected and I have had 9 steroid injections into the joints of the hand during 2011. I now have no balance at all, and cannot stand up without holding on to something. I use a walker at all times. I am unable to walk for more than a few yards outside the house, and need somebody to take me out.

My medication is as follows:

Furosemide 20m I tablet per day

Lisinopril 5mg 1 tablet per day

Clopidogrel 75mg 1 tablet per day

Coracten 20mg 1 tablet per day

Betahistine 16mg 1 tablet 3 times per day

Arcoxia 60 mg 1 tablet per day

Omeprazole 40 mg 1 tablet per day

That's the background. Now to the nightmares! I have always been prone to having vivid dreams, often in colour. However, I now experience 2 types.

The first, involves the feeling that the bedroom curtains are open. There is a glowing moonlight and the trees outside the room and swirling in a high wind. There is a lot of flashing and sometimes, figures moving past the window.

The second, involves vague white figures in the bedroom, darting about, sometimes looming over me. In both instances, this goes on for what seems a long time, and I end up screaming until I wake up. As you can imagine, my poor husband isn't getting a lot of sleep! I usually end up very breathless and sometimes there is a heaviness in the chest.

After thinking that this pattern is inevitable, it has now occurred to me that that it might have a neurological explanation. I do fall a lot, although hanging on to a walker helps to prevent this. My doctor has explained that, apart from vertigo, which floors me, there is some compression of the capillaries in the neck when I look up, which causes dizziness. The episodes tend to happen about 4 to 5 hours after going to sleep. I always start the night on my left side, and wake up about 4 hours later, needing to turn onto my back, to ease hip pain. This movement usually causes some balance problem. I have just realised that the nightmares always occur following this movement onto my back. Is it possible that the combination of slight vertigo and arthritis in the neck leads to some disturbance of brain activity?

I would be interested in your opinion.

Sylvia Brown

Dear Ms Brown,

Thanks for being in touch and my great sympathies for your several medical misfortunes over the years. These nightmares can be a feature of, neurological disorders such as Parkinsons Disease. It is also well known that physical sensations (most obviously thirst) are reflected in dreams so it is possible that the vertigo and arthritis you describe might be responsible. Beyond that nightmares may be a side effect of several drugs and I did wonder whether in your case the Coracten or Arcoxia may be a contributory factor.

Dear Dr Le Fanue,

I am 75 and I have severe osteoarthritis of the neck for at least a year ,and it is getting worse. I take paracetamol and ibruprophen without much success.The pain in my neck and head is excruciating especially at night, and sleep is difficult.

Any ideas ?

Regards,

Mrs S P I

Dear Mrs S P I,

Thanks for your query. I would have thought you would benefit from a combination of osteopathy or gentle manipulation and an epidural injection of steroids and local anaesthetic.